Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

MEDICAL CITY PLANO

Plano, TX · CCN 450651 · Rates published

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You selected 93350 (CPT)

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or

This hospital’s price: $204 across 8 payers · range $185-$934

Source: https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1682203_MEDICAL-CITY-PLANO_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D · observed 2026-03-01

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

42,029 distinct procedures filed
60 distinct payers
2,265,716 rate rows
2026-07-31 last MRF observed
Data quality

2,195,767 of 2,265,716 rate rows are consumer-grade (96.9%)

69,949 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 24,475
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 19,768
per-diem day rate — not a per-procedure price 14,259
template filing: same amount across many unrelated codes — excluded 10,035
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 1,130
placeholder amount (≤ $0.02) — excluded from medians 236
exceeds 10× this hospital's gross charge — excluded from medians 40
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 6
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1682203_MEDICAL-CITY-PLANO_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://medicalcityhealthcare.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaDiscovered by HANK
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-10-03
Content fingerprint 0e7b99a2e64a061a… · 993,104,970 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,850,948.67 $4,850,948.67 $4,850,948.67 nat. median
$2,994,107
1.6× median
845
OTHER 		Inj, Atidarsagene Autotem 20 $5,373.81 $4,955,500.00 $4,535,408.75 nat. median
$17,156
outlier · 264.4×
00845
OTHER 		Inj, Atidarsagene Autotem 2 $4,369,850.00 $4,505,000.00 $4,437,425.00 nat. median
$4,414,900
1.0× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $4,271,819.03 $4,271,819.03 $4,271,819.03 nat. median
$2,467,386
1.7× median
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 1 $3,847,800.00 $3,847,800.00 $3,847,800.00 nat. median
$2,401,965
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 21 $3,666,840.67 $4,790,847.10 $3,740,546.00 nat. median
$3,758,972
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,574,708.99 $3,685,267.00 $3,629,988.00 nat. median
$3,574,709
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 24 $6,320.33 $4,991,790.00 $3,460,974.40 nat. median
$3,325,455
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 21 $9,730.05 $4,336,566.00 $3,385,857.30 nat. median
$30,519
outlier · 110.9×
748
OTHER 		Inj, Lovotibeglogene Auto 24 $12,030.68 $4,878,762.00 $3,382,608.32 nat. median
$3,252,508
1.0× median
00908
OTHER 		Topi Adm Prad Zami Per Tr 2 $3,235,745.40 $3,335,820.00 $3,285,782.70 nat. median
$14,890
outlier · 220.7×
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,228,024.20 $3,327,860.00 $3,277,942.10 nat. median
$3,228,024
1.0× median
906
OTHER 		Inj Elivaldogene Autoteme 22 $8,597.64 $4,770,000.00 $3,275,400.00 nat. median
$25,059
outlier · 130.7×
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $3,154,932.76 $3,252,508.00 $3,203,720.38 nat. median
$3,187,420
1.0× median
00906
OTHER 		Inj Elivaldogene Autoteme 2 $3,084,600.00 $3,180,000.00 $3,132,300.00 nat. median
$3,084,600
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 24 $11,128.50 $4,409,953.50 $3,057,567.76 nat. median
$2,939,969
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,851,769.93 $2,939,969.00 $2,895,869.46 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 24 $2,455,110.00 $4,919,063.90 $2,718,430.05 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,511,311.57 $2,588,981.00 $2,550,146.29 nat. median
$2,511,312
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 2 $1,271,523.00 $4,067,128.80 $2,528,215.20 nat. median
$813,967
outlier · 3.1×
824
OTHER 		Inj, Exagamglogene Autote 26 $13,031.19 $4,617,360.00 $2,425,280.00 nat. median
$2,285,360
1.1× median
00824
OTHER 		Inj, Exagamglogene Autote 2 $2,262,040.00 $2,332,000.00 $2,297,020.00 nat. median
$2,285,360
1.0× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 2 $459,112.50 $2,937,060.00 $1,825,740.00 nat. median
$319,951
outlier · 5.7×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $536,573.93 $2,570,427.00 $1,565,413.20 nat. median
$646,415
outlier · 2.4×
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $511,793.34 $2,318,912.10 $1,412,238.36 nat. median
$622,450
outlier · 2.3×
C9301
HCPCS 		Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 1 $959,962.50 $1,544,287.50 $1,405,162.50 nat. median
$459,112
outlier · 3.1×
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 $500,948.74 $2,268,056.34 $1,381,266.75 nat. median
$640,950
outlier · 2.2×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 $23.68 $2,132,254.50 $1,271,668.90 nat. median
$739,258
1.7× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $474,717.03 $2,061,869.40 $1,255,697.04 nat. median
$591,721
outlier · 2.1×
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $6.22 $1,966,642.50 $1,172,898.50 nat. median
$608,239
1.9× median
2067
OTHER 		Afamitresgene Autoleucel 27 $766,766.90 $2,019,024.40 $809,151.00 nat. median
$793,739
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 26 $565,868.90 $1,539,641.95 $617,032.08 nat. median
$587,650
1.1× median
9194
OTHER 		Tisagenlecleucel Car-pos 26 $563,698.64 $1,484,312.01 $594,857.87 nat. median
$577,163
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 26 $559,390.19 $1,472,967.14 $590,311.26 nat. median
$562,201
1.1× median
9422
OTHER 		Idecabtagene Vicleucel Ca 26 $555,291.39 $1,462,174.32 $585,985.89 nat. median
$563,449
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $570,020.11 $587,649.60 $578,834.85 nat. median
$570,020
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 26 $529,531.24 $1,394,343.56 $558,801.81 nat. median
$533,230
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $549,535.36 $566,531.30 $558,033.33 nat. median
$549,535
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $545,335.16 $562,201.20 $553,768.18 nat. median
$545,335
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $541,339.35 $558,081.80 $549,710.57 nat. median
$541,339
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $516,226.43 $532,192.20 $524,209.31 nat. median
$516,226
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 26 $487,002.95 $1,282,359.52 $513,922.71 nat. median
$492,768
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $474,766.69 $489,450.20 $482,108.45 nat. median
$474,767
1.0× median
J9029
HCPCS 		Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 5 $61,338.53 $888,000.00 $405,600.00 nat. median
$68,423
outlier · 5.9×
74
APR_DRG 		Allogeneic Bone Marrow Transplant 9 $326,736.31 $571,789.00 $352,875.00 nat. median
$170,082
outlier · 2.1×
5834
APR_DRG 		Neonate With Ecmo 8 $335,871.71 $419,839.64 $352,665.30 nat. median
$307,206
1.1× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 21 $314,036.10 $1,273,072.13 $336,467.25 nat. median
$359,454
0.9× median
286940
CDM 		Cage Spn 2.3x32.4x34.1mm 26 $113,159.57 $838,219.00 $335,287.60 nat. median
$335,288
1.0× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 1 $332,753.88 $332,753.88 $332,753.88 nat. median
$209,753
1.6× median
90288
CPT 		Botulism Immune Globulin, Human, For Intravenous Use 1 $294,713.96 $416,525.16 $329,245.80 nat. median
$51,570
outlier · 6.4×

Other procedures at this hospital

Browse this hospital's 42,029 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 3 1 — — $4,850,948.67 $4,850,948.67 $4,850,948.67 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 32 20 $23,739.10 — $5,373.81 $4,955,500.00 $4,535,408.75 2026-07-31
00845 OTHER Inj, Atidarsagene Autotem 2 2 — — $4,369,850.00 $4,505,000.00 $4,437,425.00 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 3 1 $4,463,735.93 — $4,271,819.03 $4,271,819.03 $4,271,819.03 2026-07-31
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 3 1 — — $3,847,800.00 $3,847,800.00 $3,847,800.00 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 32 21 — — $3,666,840.67 $4,790,847.10 $3,740,546.00 2026-03-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 2 — — $3,574,708.99 $3,685,267.00 $3,629,988.00 2026-03-01
714 OTHER Inj Delandistrogene Mox R 42 24 $26,903.38 — $6,320.33 $4,991,790.00 $3,460,974.40 2026-07-31
908 OTHER Topi Adm Prad Zami Per Tr 32 21 $57,740.35 — $9,730.05 $4,336,566.00 $3,385,857.30 2026-07-31
748 OTHER Inj, Lovotibeglogene Auto 42 24 $39,790.72 — $12,030.68 $4,878,762.00 $3,382,608.32 2026-07-31
00908 OTHER Topi Adm Prad Zami Per Tr 2 2 — — $3,235,745.40 $3,335,820.00 $3,285,782.70 2026-03-01
00714 OTHER Inj Delandistrogene Mox R 2 2 — — $3,228,024.20 $3,327,860.00 $3,277,942.10 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 37 22 $50,196.06 — $8,597.64 $4,770,000.00 $3,275,400.00 2026-07-31
00748 OTHER Inj, Lovotibeglogene Auto 2 2 — — $3,154,932.76 $3,252,508.00 $3,203,720.38 2026-03-01
00906 OTHER Inj Elivaldogene Autoteme 2 2 — — $3,084,600.00 $3,180,000.00 $3,132,300.00 2026-03-01
746 OTHER Inj, Betibeglogene Autote 42 24 $43,895.58 — $11,128.50 $4,409,953.50 $3,057,567.76 2026-07-31
00746 OTHER Inj, Betibeglogene Autote 2 2 — — $2,851,769.93 $2,939,969.00 $2,895,869.46 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 39 24 — — $2,455,110.00 $4,919,063.90 $2,718,430.05 2026-03-01
09141 OTHER Inj Onase Abepar-xioi Tre 2 2 — — $2,511,311.57 $2,588,981.00 $2,550,146.29 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 9 2 — — $1,271,523.00 $4,067,128.80 $2,528,215.20 2026-03-01
824 OTHER Inj, Exagamglogene Autote 42 26 $64,304.75 — $13,031.19 $4,617,360.00 $2,425,280.00 2026-07-31
00824 OTHER Inj, Exagamglogene Autote 2 2 — — $2,262,040.00 $2,332,000.00 $2,297,020.00 2026-03-01
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 9 2 — — $459,112.50 $2,937,060.00 $1,825,740.00 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 12 4 $2,630,635.20 — $536,573.93 $2,570,427.00 $1,565,413.20 2026-07-31
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 12 4 $2,373,228.96 — $511,793.34 $2,318,912.10 $1,412,238.36 2026-07-31
C9301 HCPCS Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 6 1 — — $959,962.50 $1,544,287.50 $1,405,162.50 2026-03-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 12 4 $2,321,181.98 — $500,948.74 $2,268,056.34 $1,381,266.75 2026-07-31
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 13 4 $2,182,199.20 — $23.68 $2,132,254.50 $1,271,668.90 2026-07-31
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 12 4 $2,110,165.44 — $474,717.03 $2,061,869.40 $1,255,697.04 2026-07-31
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 13 4 $2,012,708.00 — $6.22 $1,966,642.50 $1,172,898.50 2026-07-31
2067 OTHER Afamitresgene Autoleucel 46 27 — — $766,766.90 $2,019,024.40 $809,151.00 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 43 26 $1,096,795.50 — $565,868.90 $1,539,641.95 $617,032.08 2026-07-31
9194 OTHER Tisagenlecleucel Car-pos 43 26 $1,039,331.61 — $563,698.64 $1,484,312.01 $594,857.87 2026-07-31
9413 OTHER Lisocabtagene Car Pos T 43 26 $995,962.22 — $559,390.19 $1,472,967.14 $590,311.26 2026-07-31
9422 OTHER Idecabtagene Vicleucel Ca 43 26 $1,018,294.30 — $555,291.39 $1,462,174.32 $585,985.89 2026-07-31
09498 OTHER Ciltacabtagene Car-pos T 2 2 — — $570,020.11 $587,649.60 $578,834.85 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 43 26 $968,406.12 — $529,531.24 $1,394,343.56 $558,801.81 2026-07-31
09194 OTHER Tisagenlecleucel Car-pos 2 2 — — $549,535.36 $566,531.30 $558,033.33 2026-03-01
09413 OTHER Lisocabtagene Car Pos T 2 2 — — $545,335.16 $562,201.20 $553,768.18 2026-03-01
09422 OTHER Idecabtagene Vicleucel Ca 2 2 — — $541,339.35 $558,081.80 $549,710.57 2026-03-01
09035 OTHER Axicabtagene Ciloleucel C 2 2 — — $516,226.43 $532,192.20 $524,209.31 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 43 26 $968,532.60 — $487,002.95 $1,282,359.52 $513,922.71 2026-07-31
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $474,766.69 $489,450.20 $482,108.45 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 18 5 — — $61,338.53 $888,000.00 $405,600.00 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 30 9 — — $326,736.31 $571,789.00 $352,875.00 2026-03-01
5834 APR_DRG Neonate With Ecmo 21 8 — — $335,871.71 $419,839.64 $352,665.30 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 38 21 — — $314,036.10 $1,273,072.13 $336,467.25 2026-03-01
286940 CDM Cage Spn 2.3x32.4x34.1mm 45 26 $838,219.00 $838,219.00 $113,159.57 $838,219.00 $335,287.60 2026-03-01
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 3 1 — — $332,753.88 $332,753.88 $332,753.88 2026-03-01
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 6 1 — — $294,713.96 $416,525.16 $329,245.80 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 19 5 $345,844.92 — $55,306.59 $478,449.94 $307,485.36 2026-07-31
5833 APR_DRG Neonate With Ecmo 21 8 — — $284,403.82 $355,504.78 $298,624.01 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 30 9 — — $273,588.42 $478,780.00 $295,476.00 2026-03-01
831 OTHER Obecbtge Autol Up To 400 45 27 $33,546.40 — $3,679.75 $729,015.00 $292,162.50 2026-07-31
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 17 4 $385,945.21 — $93,760.51 $582,739.61 $289,037.14 2026-07-31
897 OTHER Revakinagene, Per Implant 41 25 $23,901.95 — $263,675.00 $694,300.00 $278,250.00 2026-07-31
00831 OTHER Obecbtge Autol Up To 400 2 2 — — $269,902.50 $278,250.00 $274,076.25 2026-03-01
00897 OTHER Revakinagene, Per Implant 2 2 — — $257,050.00 $265,000.00 $261,025.00 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 58 27 — — $204,442.99 $916,157.34 $230,519.90 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 8 — — $212,601.28 $265,751.60 $223,231.34 2026-03-01
233190 CDM Implant Plvc Rt Custom 45 26 $556,327.00 $556,327.00 $75,104.15 $556,327.00 $222,530.80 2026-03-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 $1,014,848.78 — $216,966.01 $223,676.30 $220,321.15 2026-07-31
1614 APR_DRG Implantable Heart Assist Systems 26 9 — — $206,450.43 $258,063.04 $219,869.48 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 45 27 $38,325.11 — $8,051.91 $528,372.78 $211,752.45 2026-07-31
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 21 8 — — $193,411.55 $241,764.44 $203,082.13 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 17 4 $227,599.37 — $126,372.49 $574,167.94 $202,348.70 2026-07-31
00886 OTHER Inj. Remestemcel-l-rknd/ 2 2 — — $195,618.93 $201,669.00 $198,643.96 2026-03-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 2 $484,340.00 — $190,716.55 $196,615.00 $193,665.77 2026-07-31
245162 CDM Stent Eprsth 12x37mm 40 24 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $193,562.62 2026-03-01
245763 CDM Stent Eprsth 34mm 15mm 40 24 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $193,562.62 2026-03-01
248063 CDM Kit Cath Rt Heart 65 35 $594,910.00 $594,910.00 $41,643.70 $594,910.00 $189,776.29 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 19 5 $216,892.20 — $43,855.64 $389,632.46 $185,582.55 2026-07-31
252517 CDM Implant Scapula Lt Cstm 45 26 $446,526.00 $446,526.00 $60,281.01 $446,526.00 $178,610.40 2026-03-01
204426 CDM Implant Ulna Custom 45 26 $446,526.00 $446,526.00 $60,281.01 $446,526.00 $178,610.40 2026-03-01
274539 CDM Stent Eprsth 22fr 31mm 45 26 $446,526.00 $446,526.00 $60,281.01 $446,526.00 $178,610.40 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 69 32 — — $154,974.08 $693,894.24 $174,306.22 2026-03-01
273673 CDM Stent Eprsth 15cm 8mm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
275821 CDM Stent Eprsth 28x8mm 20cm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
437822 CDM Valve Aor Tavr 23mm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
281843 CDM Stent Evas 22fr 16cm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
276980 CDM Stent Evas 22fr 16cm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
277447 CDM Stent Eprsth 8x40mm 15cm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
271026 CDM Stent Eprsth 28x8mm 15cm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
C1822 HCPCS Pulse Gen Imp 120 24 $383,990.00 $383,990.00 $47,019.82 $401,850.00 $171,643.53 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 58 28 — — $155,878.14 $697,990.55 $170,541.52 2026-03-01
C2624 HCPCS System Mntr 2x15mm 4.5cm 40 24 $375,060.00 $375,060.00 $50,633.10 $375,060.00 $167,651.82 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 21 8 — — $158,189.53 $197,736.91 $166,099.01 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 21 8 — — $156,787.69 $195,984.61 $164,627.07 2026-03-01
1908 OTHER New Technology - Level 52 46 27 $339,838.95 — $146,662.80 $392,862.71 $157,444.98 2026-07-31
1907 OTHER New Technology - Level 52 46 27 $339,838.95 — $146,662.80 $392,862.71 $157,444.98 2026-07-31
212276 CDM Graft Angio Min Dstl 4cm 45 26 $386,669.00 $386,669.00 $52,200.32 $386,669.00 $154,667.60 2026-03-01
442639 CDM Kit Impl Crnl Cstm Lg 45 26 $386,245.00 $386,245.00 $52,143.07 $386,245.00 $154,498.00 2026-03-01
880563 CDM Implant Cust Cranial Xl 45 26 $374,275.00 $374,275.00 $50,527.13 $374,275.00 $149,710.00 2026-03-01
475529 CDM Artery Cryo Aortoiliac 45 26 $373,285.00 $373,285.00 $50,393.47 $373,285.00 $149,314.00 2026-03-01
5832 APR_DRG Neonate With Ecmo 21 8 — — $141,711.93 $177,139.91 $148,797.53 2026-03-01
01908 OTHER New Technology - Level 52 2 2 — — $142,262.92 $146,662.80 $144,462.86 2026-03-01
01907 OTHER New Technology - Level 52 2 2 — — $142,262.92 $146,662.80 $144,462.86 2026-03-01
1906 OTHER New Technology - Level 51 46 27 $306,412.27 — $132,237.00 $354,220.59 $141,958.64 2026-07-31
1905 OTHER New Technology - Level 51 46 27 $306,412.27 — $132,237.00 $354,220.59 $141,958.64 2026-07-31
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 21 8 — — $134,564.75 $168,205.94 $141,292.99 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 2 $568,197.06 — $134,420.85 $138,578.20 $136,499.53 2026-07-31
207702 CDM Vsp Recon Maxillofacial 45 26 $337,284.00 $337,284.00 $45,533.34 $337,284.00 $134,913.60 2026-03-01
255241 CDM Kit Osteot Cstm N/impl 65 35 $416,321.00 $416,321.00 $29,142.47 $416,321.00 $132,806.40 2026-03-01
263482 CDM Device Clsr 27mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
263484 CDM Device Clsr 35mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
263480 CDM Device Clsr 20mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
263481 CDM Device Clsr 24mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
263483 CDM Device Clsr 31mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
263485 CDM Device Clsr 40mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 21 8 — — $125,047.72 $156,309.65 $131,300.11 2026-03-01
5831 APR_DRG Neonate With Ecmo 21 8 — — $124,780.17 $155,975.21 $131,019.18 2026-03-01
01906 OTHER New Technology - Level 51 2 2 — — $128,269.89 $132,237.00 $130,253.45 2026-03-01
01905 OTHER New Technology - Level 51 2 2 — — $128,269.89 $132,237.00 $130,253.45 2026-03-01
745290 CDM Stent Eprsth 34mm 15cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
872288 CDM Stent Eprsth 34mm 20cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
751780 CDM Stent Eprsth 45mm 15cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
871762 CDM Stent Eprsth 37mm 15cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
745289 CDM Stent Eprsth 15cm 28mm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
272724 CDM Stent Vasc 250mm 10mm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
754486 CDM Stent Eprsth 10cm 26mm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
747431 CDM Stent Eprsth 40mm 20cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
878283 CDM Stent Eprsth 31mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
877803 CDM Stent Eprsth 40mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
875236 CDM Stent Eprsth 37mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
875235 CDM Stent Eprsth 45mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
273109 CDM Stent Vasc 250mm 16mm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
853516 CDM Stent Eprsth 37mm 20cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
867229 CDM Stent Eprsth 28mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
745288 CDM Stent Eprsth 34mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
866977 CDM Stent Eprsth 31mm 15cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
853517 CDM Stent Eprsth 45mm 20cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
466919 CDM Stent Graft 15cn 28x28mm 45 26 $320,623.00 $320,623.00 $43,284.11 $320,623.00 $128,249.20 2026-03-01
339477 CDM Graft Evas 40x40x10cm 45 26 $320,623.00 $320,623.00 $43,284.11 $320,623.00 $128,249.20 2026-03-01
875223 CDM Impl Crnl Lg 45 26 $319,642.00 $319,642.00 $43,151.67 $319,642.00 $127,856.80 2026-03-01
C1820 HCPCS Device Neurostimulator 480 24 $285,090.50 $285,090.50 $33,245.91 $316,033.00 $126,645.32 2026-03-01
244953 CDM Kit Cath Rt Heart 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
422506 CDM Kit Pmp Rt Hrt 22f 170cm 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
265596 CDM Kit Lo Prfl Comp Shth 7f 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
254667 CDM Cath Vasc Assist Strl 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
751731 CDM Pump Cath Lv Impella 9fr 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
866357 CDM Set Pump 21fr 5.0 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
862710 CDM Set Vntrc 17.4x13.8in 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
1903 OTHER New Technology - Level 50 46 27 $272,985.60 — $117,811.20 $315,578.48 $126,472.29 2026-07-31
1904 OTHER New Technology - Level 50 46 27 $272,985.60 — $117,811.20 $315,578.48 $126,472.29 2026-07-31
267810 CDM Cage Spnl 0d 12x14x20mm 45 26 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $126,313.20 2026-03-01
422111 CDM Implant Cust Cranial Lge 45 26 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $126,313.20 2026-03-01
864258 CDM Cage Brgd 20d 8x24x34 45 26 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $126,313.20 2026-03-01
864569 CDM Cage Brgd 20d 10x34x24 45 26 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $126,313.20 2026-03-01
473595 CDM Stent Thor 20f 26x21x10 45 26 $314,336.00 $314,336.00 $42,435.36 $314,336.00 $125,734.40 2026-03-01
467990 CDM Stent Graft 20cm 45x45mm 45 26 $314,336.00 $314,336.00 $42,435.36 $314,336.00 $125,734.40 2026-03-01
481638 CDM Graft Evas 34x34x10cm 45 26 $314,336.00 $314,336.00 $42,435.36 $314,336.00 $125,734.40 2026-03-01
469404 CDM Stent Graft 10cm 21x21mm 45 26 $314,336.00 $314,336.00 $42,435.36 $314,336.00 $125,734.40 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 30 9 — — $115,292.76 $201,762.00 $124,516.00 2026-03-01
468029 CDM Stent Eprsth 40x40x20cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
101241 CDM Graft Evas 45x45mm 10cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
467548 CDM Stent Eprsth 34x34x20cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
473613 CDM Stent Eprsth 37x37x20cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
459729 CDM Stent Eprsth 37x37x15cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
473088 CDM Stent 20fr 31x31mm 10cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
244589 CDM Stent Thor 31x26mm 10cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
471570 CDM Stent Eprsth 40x40x15cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
483550 CDM Stnt Thorac 26x26mm 10cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
472852 CDM Stent 34mmx34mmx15cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
205234 CDM Cann W Dilator Strgt Tip 65 35 $383,380.00 $383,380.00 $26,836.60 $383,380.00 $122,298.22 2026-03-01
101317 CDM Stent Graft 15cm 31x31mm 45 26 $304,832.00 $304,832.00 $41,152.32 $304,832.00 $121,932.80 2026-03-01
205115 CDM Stnt Thorac 28x28mm 10cm 45 26 $304,832.00 $304,832.00 $41,152.32 $304,832.00 $121,932.80 2026-03-01
471891 CDM Graft Evas 45x45mm 15cm 45 26 $304,832.00 $304,832.00 $41,152.32 $304,832.00 $121,932.80 2026-03-01
472308 CDM Stent Eprsth 31x31x20cm 45 26 $304,832.00 $304,832.00 $41,152.32 $304,832.00 $121,932.80 2026-03-01
473093 CDM Stent Eprsth 37x37x10cm 45 26 $304,832.00 $304,832.00 $41,152.32 $304,832.00 $121,932.80 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 8 — — $114,074.89 $142,593.61 $119,778.63 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 8 — — $113,553.51 $141,941.89 $119,231.19 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 21 8 — — $113,259.87 $141,574.84 $118,922.86 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 21 8 — — $112,772.99 $140,966.24 $118,411.64 2026-03-01
C1882 HCPCS Crt-d Amplia Dtmb1qq 760 24 $258,325.00 $258,325.00 $13,517.28 $400,950.00 $118,081.39 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 21 8 — — $111,646.65 $139,558.31 $117,228.98 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 49 28 $599,885.67 — $108,147.24 $629,884.36 $117,066.60 2026-07-31
C1767 HCPCS Device Ipg Sleep 51mm 520 24 $290,779.00 $290,779.00 $12,144.60 $446,526.00 $116,281.40 2026-03-01
235623 CDM Device Embl 4mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
247231 CDM Device Embl 2.5mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
218838 CDM Stent Aaa Xcldr 12cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
425738 CDM Device Embl 25mm 4.5mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233056 CDM Device Embl 4mm 35mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
235622 CDM Device Embl 4mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
228497 CDM Device Embl Flx 14x5mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
231698 CDM Device Embl 4.25mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
223314 CDM Device Embl 4x12mm Pline 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
277815 CDM Stent Vasc 350mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
231788 CDM Graft Endo Aaa 23x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233053 CDM Device Embl 3.75mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
211753 CDM Graft Endo Aaa 28.5x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233054 CDM Device Embl 4.75mm 25mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
244943 CDM Device Embl 4mm 10mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
247229 CDM Device Embl 10mm 2.5mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
261272 CDM Device Embl 4.25mm 10mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
220252 CDM Device Embl 14mm 2.5mm P 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
277448 CDM Stent Eprsth 4.3x40mm 6c 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
229410 CDM Device Emb 5mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
270082 CDM Device Embl 5.0x16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
251775 CDM Coil Emb Neuro 6x4mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
276858 CDM Coil Embol Neuro 4x2mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
234084 CDM Device Embl 4.75mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
258504 CDM Graft Vasc 36/28 199mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
234142 CDM Device Embl 3.5mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232561 CDM Device Embl 3.50x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233051 CDM Device Embl 4.25mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
240458 CDM Device Embl 4.75x30mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
270080 CDM Device Embl 4.00x2mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
270479 CDM Device Embl 4.50x25mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
242042 CDM Stent Grft 23x12mm 12cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
248655 CDM Device Embl 5mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
284916 CDM Stent Vasc 250mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
270083 CDM Device Embl 5mm 25mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233052 CDM Device Embl 4.5mm 35mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232591 CDM System Imp 5mm 15mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
231696 CDM Device Embl 4.75mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
244942 CDM Device Embl 4.25mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
223010 CDM Coil Embl Endo 9mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
234048 CDM Device Embl 4mm 30mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
254564 CDM Device Embl 3mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
244389 CDM Device Embl 3.5mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
463852 CDM Device Embl Pln 4.5x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233049 CDM Device Embl 5.0x20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232510 CDM Device Embl 4mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
216750 CDM Graft Endo Aaa 36x14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
279418 CDM Device Embl 4mm 25mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
267263 CDM Device Embl 4.50x16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
857807 CDM Graft Evas 35x14.5m 14cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
248261 CDM Device Embl 3.5mm 10mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
221145 CDM Graft Evasc 20x12mmx12cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232511 CDM Device Embl 3.75mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
258797 CDM Valve Aortic 27mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
235825 CDM Device Embl 3mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
230328 CDM Device Embl 3.5mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
274124 CDM Device Embl 400mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
216719 CDM Graft Endo Aaa 26x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
250130 CDM Device Embl 3.75x16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
204057 CDM Valve Aortic 27mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
216652 CDM Graft Endo Aaa 32x14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
480921 CDM Coil Emb Endo Sn Ly 7mmx 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
230329 CDM Device Embl 3.25mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232560 CDM Device Embl 3.75mm 10mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
231983 CDM Device Embl 4.5mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
240461 CDM Device Embl 5mm 35mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232314 CDM Device Embl 3mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
276815 CDM Coil Emb Neuro 7mm 2mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233599 CDM Device Embl 3.25mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
235860 CDM Device Embl 3mm 10mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
174251 CDM Device Embl 10mm 5mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
870971 CDM Graft Evas 26x12mm 16cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
252222 CDM Device Embl 2.75mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
222589 CDM Gft Evs 15f 20x14.5x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
472784 CDM Device Embl 18mm 2.5mm P 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
254326 CDM Device Embl 4.5mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
254671 CDM Device Embl 4.75mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
240704 CDM Coil Emb Neuro 6x3mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
279420 CDM Device Embl 4.75mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233300 CDM Device Embl 3.25x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
250131 CDM Device Embl 3.5mm 18mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
864475 CDM Valve Aor Crdgft 22mm Lg 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
858902 CDM Graft Evas 31x14.5m 13cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
870016 CDM Graft Evas 23x14.5m 16cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
433365 CDM Occluder Cv 18x18mm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
737806 CDM Grft Xcldr Aaa 31/14/15 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
433364 CDM Occluder Cv 35x18mm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
857566 CDM Graft Evas 31x14.5m 15cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
433363 CDM Occluder Cv 25x18mm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
879077 CDM Graft Evas 26x12mm 18cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
872483 CDM Graft Evas 26x12mm 14cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
870014 CDM Graft Evas 23x12mm 16cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
870031 CDM Graft Evas 26x14.5m 18cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
870013 CDM Graft Evas 14.5mm 18cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
866807 CDM Graft Evas 18cm 23mm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
869126 CDM Graft Evas 16cm 26mm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
01904 OTHER New Technology - Level 50 2 2 — — $114,276.86 $117,811.20 $116,044.03 2026-03-01
01903 OTHER New Technology - Level 50 2 2 — — $114,276.86 $117,811.20 $116,044.03 2026-03-01
282543 CDM Guide Prnt 3d Bn Hrvt 65 35 $361,629.00 $361,629.00 $25,314.03 $361,629.00 $115,359.65 2026-03-01
C1772 HCPCS Pump Pain Infn 20ml 80 24 $257,884.00 $257,884.00 $34,642.08 $259,160.00 $115,270.32 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 70 32 — — $101,773.13 $452,829.97 $114,989.07 2026-03-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 17 4 $143,344.23 — $39,976.89 $203,447.46 $114,857.36 2026-07-31
1613 APR_DRG Implantable Heart Assist Systems 26 9 — — $107,604.75 $134,505.94 $114,598.99 2026-03-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 21 8 — — $108,705.44 $135,881.80 $114,140.71 2026-03-01
715751 CDM Spacer Peek 12d D30mmxw3 45 26 $285,231.00 $285,231.00 $38,506.18 $285,231.00 $114,092.40 2026-03-01
447250 CDM Cage Spn 5d 9x8x23mm 45 26 $284,502.00 $284,502.00 $38,407.77 $284,502.00 $113,800.80 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 21 8 — — $107,731.67 $134,664.59 $113,118.25 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 8 — — $107,036.06 $133,795.08 $112,387.86 2026-03-01
480949 CDM Cage Spn Cncrd 9x7x23 45 26 $278,927.00 $278,927.00 $37,655.14 $278,927.00 $111,570.80 2026-03-01
1901 OTHER New Technology - Level 49 46 27 $239,558.93 — $103,385.40 $276,936.36 $110,985.94 2026-07-31
1902 OTHER New Technology - Level 49 46 27 $239,558.93 — $103,385.40 $276,936.36 $110,985.94 2026-07-31
426806 CDM Device Embl 25mm 3.75mm 45 26 $276,473.00 $276,473.00 $37,323.86 $276,473.00 $110,589.20 2026-03-01
423709 CDM Device Embl 5x30mm 45 26 $276,473.00 $276,473.00 $37,323.86 $276,473.00 $110,589.20 2026-03-01
245865 CDM Dressing Wnd 20x40cm 60 33 $337,284.00 $337,284.00 $23,609.88 $337,284.00 $110,291.87 2026-03-01
207698 CDM Kit Implant Crnmxf Med 45 26 $274,294.00 $274,294.00 $37,029.69 $274,294.00 $109,717.60 2026-03-01
216456 CDM Cannula Dual 31fr 51cm 65 35 $343,720.00 $343,720.00 $24,060.40 $343,720.00 $109,646.68 2026-03-01
240399 CDM Cannula Introd 29fx46cm 65 35 $343,720.00 $343,720.00 $24,060.40 $343,720.00 $109,646.68 2026-03-01
877253 CDM Cannula Prfsn Str Dil Cr 65 35 $343,720.00 $343,720.00 $24,060.40 $343,720.00 $109,646.68 2026-03-01
875506 CDM Can Prfsn 22fr Vsn 20d 65 35 $343,720.00 $343,720.00 $24,060.40 $343,720.00 $109,646.68 2026-03-01
480948 CDM Cage Spn 5d 9x8x23mm 45 26 $273,458.00 $273,458.00 $36,916.83 $273,458.00 $109,383.20 2026-03-01
270458 CDM Cage Spn 18mm 24mm 45 26 $270,009.00 $270,009.00 $36,451.21 $270,009.00 $108,003.60 2026-03-01
265452 CDM Cage Spnl Exp 18mm 45 26 $270,009.00 $270,009.00 $36,451.21 $270,009.00 $108,003.60 2026-03-01
100901 CDM Coil Emb Endo 6mm 4.6mm 45 26 $267,007.00 $267,007.00 $36,045.94 $267,007.00 $106,802.80 2026-03-01
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